Provider Demographics
NPI:1356455265
Name:NEAL, ELIZABETH SANDRA (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SANDRA
Last Name:NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8808 BRONCO LANE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-4781
Mailing Address - Country:US
Mailing Address - Phone:512-267-1877
Mailing Address - Fax:512-267-1726
Practice Address - Street 1:2760 GODWIN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8501
Practice Address - Country:US
Practice Address - Phone:757-983-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9273207Q00000X
VA0101278047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281922902Medicaid